International Research Journal of Medical Sciences ____________________________________ ISSN 2320 7353

Vol. 2(8), 9-12, August (2014)

Int. Res. J. Medical Sci.

Prevalence of Dermatophytoses in Rural Population of Garhwal Himalayan

Region, Uttarakhand, India
Anup Kainthola, Puneet Gaur, Alkesh Dobhal and Shailendra Sundriyal
Department of Botany and Microbiology, HNB Garhwal University (A Central University), Srinagar, Uttarakhand-246174, INDIA

Available online at: www.isca.in, www.isca.me

Received 23rd July 2014, revised 6th August 2014, accepted 26th August 2014

Abstract
To assess the prevalence and factors contributing in developing dermatophytoses in rural population of Garhwal Himalayan
Region, a cross sectional study of 12 villages was done family to family from 1-Jan-2013 to 28-Aug-2013 and a total of 106
samples were taken into study from subjects who didnt attend OPD and were not receiving any anti fungal treatment.
Samples were tested by potassium hydroxide [KOH] examination. Macroscopic and Microscopic examination of direct
sample and corresponding culture was done to identify the etiologic agent. All of 106 samples were found KOH positive
whereas 74 [69.81 %] samples were culture positive. Amongst culture positive samples, clinical type Tinea capitis was found
predominant with 43.24% prevalence followed by Tinea corporis and Tinea pedis 28.38% and 18.92% respectively. Tinea
cruris was found least with 9.46 % occurrence. Males [64.86%] were more prone to dermatophytoses than females
[35.14%]. A pretested questionnaire, to assess prevalence was designed and data was collected and analyzed.
Keywords: Close contacts with livestock, overcrowding in family and low personal hygiene, bare foot farming were primary
reasons for the development of dermatophytoses. Improving awareness of peoples about the dermatophytoses can minimize
the prevalence of this disease.

Introduction

Methodology

Dermatophytoses, a major public health problem throughout the

world is caused by a group of microorganisms called
Dermatophytes, lesions of which are characterized by circular
disposition, desquamation, alopecia and erythema of the edges1.
There are three genera of dermatophyte, Trichophyton,
Microsporum and Epidermophyton2.

Physiography of the area: The present study was conducted in

the 12 Villages of Joshimath district of Uttarakhand, Garhwal
Himalayan Region namely; Saundari, Badagaon, Dhaak,
Tugaasi, Karchhi, Raigari, Karchhaun, Bhangyul, Ringgi,
Subhhain, Reni, and Merugh, that lies between Latitude
30340 N and Longitude 79340 E and at 3124 msl height.

As the transmittance of the dermatophytoses merely require

contact and low personal hygiene, its occurrence in a
community may become persistent. Keeping in view the fact
that dermatophytoses and other fungal infections are readily
caught by immunocompromised individuals which are
increasing critically at sharp rate3. Frequent incidences of
dermatophytoses have become a serious problem to counter and
manage. Climatic and ambient environmental conditions do
favors the growth of certain dermatophytes4. India is a large
subcontinent with remarkably varied topography. Its climate is
conductive to the acquisition and persistence of dermatophytic
infection.

Collection of Samples: After receiving an informed consent

from each individual included in this study, a total of 106
samples were collected and investigated from those individuals
who were found clinically suspected for dermatophytoses and
were not receiving any antifungal treatment from beginning of
the infection and subjected to mycological examination. To
remove the dirt or other ointments if any, after wiping the
infected areas or lesions with 70% alcohol, Samples from scalp,
nails, foot webs and skin scrapings were collected in pre
sterilized black paper sachet [13x12cm]. Pieces of discolored,
broken nails and scrapings were taken from the advancing
borders and edges of infection with the help of blunt sterile
scalpels were taken.

The present study aims to report the prevalence and distribution

of 4 predominant clinical types of Dermatophytoses and to find
out the parametres contributing in its prevalence in rural
population of Garhwal Himalyan region that dont have access
to the health care facilities due to adverse geographical
locations.

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Isolation and culturing of Dermatophytes: Prior to 10% KOH

examination, Samples were made free of any small hairs
aseptically using sterile forcep. All 106 samples collected were
subjected to direct microscopic observation. After confirmation
of fungal elements, samples were streaked on to modified
Sabouraud Dextrose Agar [SDA] plates and slants enriched with
cyclohexamide [0.5 mg/ml], chloramphenicol [0.05 mg/ml] [Hi9

International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 7353

Vol. 2(7), 9-12, August (2014)
Int. Res. J. Medical Sci.
media] and incubated for 5 weeks5. Cultures without any
apparent fungal growth after 5 weeks were treated as Culture
negative and discarded.
All mycological Identifications were done by macroscopic and
microscopic observation of culture isolates by examining the
surface morphology, texture, and pigmentation on the reverse
side of colony6. Lactophenol cotton Blue staining was done for
each culture positive sample to observe mycelial type, conidial
arrangement [macro and micro conidia] to differentiate between
species and genera.
Survey methodology and statistical analysis: In order to
assess the prevalence of dermatophytoses on the basis of age,
sex, education and profession of rural population its
management, a pretested and structured questionnaire was
designed to asses the living standards and other. All individuals
participated in the study were informed and consent was taken
verbally and in written. A value of P < 0.05 was taken as
significant.

Results and Discussion

Amongst 106 samples taken, only 74 (69.81%) were culture
positive and subjected for further investigation. Microscopical
and macroscopical observation suggested the high prevalence of
clinical type Tinea capitis with 43.24% (table 1) followed by
Tinea corporis and Tinea pedis 28.38% and 18.92%
respectively. Tinea cruris was found least with 9.46%
occurrence. We observed that close contacts, over crowding in
family and low personal hygiene were primary regions for the
development of the dermatophytoses.
Table-1
Etiology of Dermatophytoses. (P<0.05)
Isolates
Males
Females
Etiological
Agent
No.
%
No.
%
No.
%
Trichophyton
32
43.24 23 71.87 09 28.15
rubrum
Trichophyton
21
28.38 12 57.14 09 42.85
mentagrophytes
Epidermophyton
14
18.92 08 57.14 06 42.85
floccosum
Trichophyton
07
9.46
05 71.42 02 28.57
Verrucosum
Total
74
100
48
64.8
26
35.2
People with habit of bare feet farming, poor hygienic status and
having close contacts with livestock were found to comprise the
major infected group in all (table 2).
Susceptibility by age and gender: Of the 74 culture positive
samples, the dermatophytoses infection was found prominent in
the age group of 20-40 [31.08%] and 40< [28.37%] years [table
2a]. Males were found to be more susceptible to the
dermatophytoses as studied by earlier investigators7-9. Taking

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occasional bath and wearing of tight cloths in winter season that

lasts till march in Himalayan region is a major reason for having
such infections. Education however was found as negligible
factor as all educational groups viz. primary and secondary were
infected with nearly equal percent of occurrence.

S.
No.
1
2
3
4
Total

Table-2
Prevalence of dermatophytoses as per Age
Age
No. of
Males
Females
patient(s)
(%)
(%)
1-10
13
8
61.53
5
38.46
10-20
17
11
64.70
6
35.29
20-40
23
15
65.21
8
34.78
>40
21
14
66.66
7
33.33
74
48
64.86
26
35.13

Prevalence of dermatophytoses as per Occupation

Occupation
Farmer
Laborers
House Makers
Students
Total

No. of
patient
(s)
11
9
13
41
74

Males

(%)

Females

(%)

11
9
24
44

100
100
58.53
59.45

13
17
30

100
41.46
40.54

Prevalence of dermatophytoses as per Educational

Qualification
Educational
No. of
Males
Females
Qualification
Patient(s)
(%)
(%)
<5
21
9
42.85
12
57.14
5-10
29
16
55.17
13
44.82
>10
24
15
62.5
9
37.5
Total
74
40
54.05
34
45.94
Discussion: There are reports of emergence of high occurrence
of dermatophytoses from different parts of the world7. Though
on receiving prompt treatment most of the infections are
checked but dwellers of geographically distinct areas those who
are not availing primary facilities like primary health care
centers are always at high risk of persistent infection.
Dermatophytoses if not treated, may sometime go latent and
transmits to the healthy population by all possible ways of
transmission i.e. through sharing of things and close contacts
which in turn leads to the prevalence in symptomatic
carriers10-11. Interior rural population of high altitude regions of
Garhwal Himalayas, thus constitute a privileged site for
epidemiological study of dermatophytoses along with
ascertaining the factors contributing in emergence and
developing of the infection. Occurrence of dermatophytoses
with respect to particular gender has been studied earlier with
different views, which does not come to a significant conclusion
that either of gender is more susceptible to the infection. Some
studies have shown that males are at the higher risk of
acquisition of infection12-15. However, others have reported
females of being more prone4,10,16. Of the 106 samples taken

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International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 7353

Vol. 2(7), 9-12, August (2014)
Int. Res. J. Medical Sci.
69.81% i.e. 74 were culture positive. High prevalence of
Trichophyton rubrum and Trichophyton mentagrophytes
followed by Epidermophyton floccosum and Trichophyton
verrucosum was found with males [64.86%] being more prone
to the dermatophytoses. Our study reports that species of
Trichophyton genus was responsible of majority of the infection
[71.31%] which is also supported by reports of other
investigators17-19. In this study our findings provide further
evidence for the existence of the strong correlation between
occurrence of dermatophytoses and living standards. Our results
are in good agreement with the earlier studies8,9,20. We observed
that the lack of knowledge about dermatophytoses, carelessness
towards treatment [as it was a general notion that
dermatophytoses doesnt cause serious problems], remoteness
from health care units and low personal hygiene were the
apparent factors for the continuous existence of
dermatophytoses in the community. A value for P to be greater
than 0.05 makes the study statistically significant.

Figure-1
Clinical photographs showing grey scaling with roughness in
hands by T. rubrum

Figure-4
Advancing border of infection of ringworm pattern in Tinea
corporis

Conclusion
The present study indicates the widespread occurrence and
dissemination of dermatophytoses in Garhwal Himalayan region
and suggests for the establishment of healthcare units and
upgrading the beliefs of rural population about dermatophytoses
infection and its consequences. Our study supports the belief
that age group 20-30 years is considered as highly active group
and there are greater chances of interaction between them
leading to dissemination of fungal infections (dermatophytoses)
more rapidly in the community. It was well observed during the
study that level of knowledge about dermatophytoses or other
fungal infections was below average in the local dwellers and
hence further worsened the situation in this part of India. Hence,
an abrupt intervention is needed in the form of upgrading their
knowledge, precautions and need for urgency of treatment.

Acknowledgement
Authors acknowledge the support of rural population of
Garhwal Himalayan region in making the study possible.

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papulosquamous appearance and fissuring in Tinea pedis

Figure-3
Photograph showing broken and weakened hairs in Tinea
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International Research Journal of Medical Sciences ________________________________________________ ISSN 2320 7353

Vol. 2(7), 9-12, August (2014)
Int. Res. J. Medical Sci.
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